Healthy Minds Healthy Bodies Personal Interest Form

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If you are interested in learning more about the Healthy Minds Healthy Bodies fitness initiative for military personnel who have returned home with disabilities, please complete and submit this Personal Interest Form.

First Name*

Last Name*

Gender*

Date of Birth*

Date of Birth

Phone Number*

Email Address*

Driver License Number*

Street Address*

City*

State*

Zip*

County*

Did you receive a discharge under honorable conditions? *

Yes

No

Can you provide verification of honorable discharge and 10% or more disability?

Yes

No

Prince George's County Department of Parks and Recreation does not keep these documents on file. Documentation must be presented for visual verification only.